Between Your Navel and Your Knees

Let’s take a moment to review the current state of American women’s access to the full range of reproductive health services. It keeps popping up in the media, and it’s no mystery why. Although everyone says the economy is the priority during this election year, politicians know that “social issues” like reproductive rights and same sex marriage get more media and public attention. While people may shrug about this or that economic fix, the intensity of opinion on abortion and homosexuality tends to inspire action, like demonstrations, marches, protests, petitions, or letters to the editor. Lately it seems the most heated public debate centers on a woman’s most private parts, as illustrated by recent Virginia politics.

First, a little background. Ever since the U.S. Supreme Court held in 1973 that a woman’s constitutionally protected right to privacy included a qualified right to terminate her pregnancy under certain circumstances, opponents of the decision have worked to make it harder and more expensive to obtain an abortion. Unable to overturn the decision or make it illegal by an act of Congress, abortion opponents have made state legislatures the focus of their efforts. In the past 40 years, state laws have been passed that restrict the circumstances in which abortions can be performed in a variety of ways. Some require a waiting period of up to several days between the time a woman meets with the provider and the procedure itself. This restriction necessitates multiple appointments, transportation, requests for time off from work, and extra childcare. Some states require the woman receive “counseling”, which consists of certain statements about the fetus’ sensitivity to pain, or gestational status, or the possibility that terminating her pregnancy will predispose her to the possibility of certain mental or physical consequences, such as depression or breast cancer. Some state have laws establishing standards for the building, like width of the hallways, and facilities in which abortions are performed, increasing the cost of equipment, procedures and personnel. As a result, a number of women’s health clinics have closed, and the routine preventive care they provided became unavailable. In 2011 alone, over 1100 state bills were introduced regarding reproductive rights and a record 92 new restrictions became state law that same year.

The Virginia legislature took up a bill that would require all women seeking abortion to undergo an ultrasound. Before the bill reached the governor’s desk for signature, it was reported that the effect of the bill would be to require that a probe would be inserted in the woman’s vagina to obtain the imaging. Lawmakers weren’t fully aware, at first, that an ultrasound in the first trimester necessarily involved an interior view. However, in early pregnancy, an abdominal ultrasound is not sufficiently sensitive to detect a fetus from outside the woman’s body. When phrases such as “vaginal probe” and “transvaginal ultrasound” started circulating, opponents found their voice. It’s worth noting that the Virginia legislature is almost exclusively male, and none but three are medical doctors. The hue and cry prompted the Governor to reverse his earlier statement of support, sent the bill back to its sponsor, who subsequently withdrew it. The delegates are now considering whether to require only the ultrasound from outside the woman’s abdomen before allowing an abortion to proceed, and it looks likely to pass. In the first trimester, (when most abortions are obtained) such an ultrasound would be entirely useless, and serve only to increase the expense of terminating the pregnancy, which the woman will have to pay.

Although Virginia got all the attention, the exact same requirement, including the insertion of the ultrasound probe into the women’s vagina, has been enacted in other states, such as Texas and North Carolina. Alabama is considering one. Laws mandating ultrasounds in some states require that the woman look at the image, and/or have it described to her by the doctor. Eight states refuse to let insurance carriers issuing private insurance plans in those states offer coverage for pregnancy termination. In 43 states, health care providers are allowed to refuse to perform abortions by means of a “conscience exception”. So, while it is true that abortions are currently legal, they have become progressively more difficult to obtain, and states have been very effective in limiting access as a practical matter.

The accelerated pace at which state lawmakers are pushing anti-abortion provisions does not appear to be slowing down any time soon, and the bills are getting more and more restrictive. At least 10 states are introducing or gathering votes for fetal personhood bills, which would define a “person” in the state constitution from the moment of fertilization. Ohio Republicans are pushing a bill that would ban abortions after the fetal heartbeat can be detected, which occurs as early as six weeks into a pregnancy. Further, a Florida lawmaker introduced a relatively extreme bill last week that would make abortion a felony and send doctors to prison for life for performing the procedure unless they can prove the woman’s life was in danger.

Whatever your personal convictions, religious beliefs or political loyalties, public policy affects your reproductive process, sometimes in ways you didn’t expect. It’s an important thing to know as a citizen, a woman, and a mother.

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